Pathological Demand Avoidance

Do you ever feel like your child cant tolerate demands or engaging in simple mundane activities? There is a new diagnosis called Pathological Demand Avoidance which helps explain why certain children have difficulties tolerating demands.

 What is Pathological demand avoidance?

Pathological Demand Avoidance is considered a part of autism spectrum disorder; more specifically, it is a child’s extreme anxiety-driven need to control their environment and the demands that people make of them. Children often use large outbursts and other ‘socially embarrassing’ or ‘undesirable’ behaviours when presented with directions or demands of their behaviour. This behaviour is not the product of poor parenting or a defiant child, it is a pathological resistance to any demand made on a child’s behaviour.

Key features of a PDA profile

“The main feature of PDA is being resistant and avoiding the ordinary demands of life”

This doesn’t just mean resisting demands such as ‘go to school’, it is also avoiding everyday activities such as eating meals or having a shower. These demands are often avoided simply because they are demands. There is nothing inherently bad or frightening about them. However, children often resist because they may fear not being in control of their lives and decisions. As such, they react with aggressive avoidance to maintain a semblance of control.

Children may use social strategies to avoid everyday demands. These strategies can range from distractions and procrastination to aggressive behaviours, social outbursts and self-harm. For example, children will often begin by procrastinating tasks or attempting to distract others before escalating to more drastic measures such as taking one’s clothes off in public or engaging in outbursts that gain the attention of others in public spaces.

These social avoidance strategies are often accompanied by extreme mood swings. For example, some children may have such emotional reactions that many feel they must be cautious around them, whereas other children may be withdrawn and appear to internalise their emotions.

“Another key symptom of PDA is the child may have obsessive behaviours focussed on other people such as a friend or parent” . The child may want to control the interaction with another person or attempt to copy their behaviour and appearance.

PDA is hard to identify or separate from typical avoidance in children because they may appear friendly and have a keen understanding of social interaction. Children with APD may have good verbal fluency, articulate language, and be talkative and expressive in their use of language. However, features that separate children with APD and those without include the child likely not respecting the social hierarchy, attempting to control interactions with others and engaging in very rigid play that is inflexible.

When to consider seeking help? 

There is no perfect way to know when you should seek professional help for your child. However, some key signs of needing intervention are if the child refuses to engage in ordinary tasks necessary for a healthy lifestyle, such as showering and brushing their teeth. Further, if children refuse to attend school or do school-related tasks, it may be beneficial to seek professional help.

While these indicators suggest that you may need professional assistance, they are not the only signs. If your child’s behaviour is causing them or yourself distress, then you would benefit from seeking aid

Treatment and helpful approaches for parents 

The PDA society in the UK has outlined some tips and approaches for parents of children with PDA to help manage their refusal and distress.

Although many children with PDA also have an autism diagnosis, the typical approaches, such as having routine and structure, are often counterproductive for children with PDA. As such, the PDA society has outlined that a partnership between child and parent based on trust and collaboration can help manage the distress. To create this partnership:

• Choose your battles carefully → It is easiest to accept that some things cannot be done, but for those activities that must, it is helpful to explain the reason for doing so and minimise the rules surrounding that activity.
• Prevention → Parents can reduce the uncertainty children experience by outlining all the steps involved and planning ahead for any potential changes to structure.
• Negotiation → Negotiating the terms of the demand calmly and collaboratively can help your child feel more in control of the situation. However, it is helpful to monitor their responses and if your child starts to exhibit distress, adapt your demands to help keep them calm.